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IPFC-3 VTE+ Men’s Health > BPH > Flashcards

BPH Flashcards

(58 cards)

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1
Q

What is hyperplasia

A

Increase in the # of cells (hypertrophy —- increase in cell size)

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2
Q

T or F: BPH is the most common cause of urinary dysfxn symptoms in old men

A

T
- peak incidence at 60
- 80-90% will have evidence by age 80

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3
Q

T or F: before puberty, the prostate is the size of a pea (1g) and grows to 15-20g by 25-30

A

T
- after 40 it can also quadruple in size
normal is around 40g

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4
Q

T or F: there are clear defined RF for BPH

A

F- other then age , not clearly defined but may include
- high levels of endogenous test/DHT or estradiol
- high levels of insulin like GF
-obesity
- DM
- high levels of alcohol consumption
- physical activity

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5
Q

T or F: For BPH to develop, you need to have a normal functioning testes

A

T- need testes to make test—- DHT
- DHT is central in BPH development

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6
Q

Which prostate tissue is generally responsible for BPH/growth

A

Stromal tissue primarily
- E:S ratio increases from 2:1 to 5:1

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7
Q

What are the 2 components of BPH

A

Static: increase in SM + epithelial proliferation via DHT resulting in increase in anatomical size of prostate (block bladder + urethra)
- androgen receptors (blocking

Dynamic: increase in SM tone (contraction etc) in prostate + bladder via alpha-1 receptors
- constricting

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8
Q

What is the general progression seen in BPH

A

BPH
—- BPE: benign prostate enlargement : prostate large + may make urine slow/take longer to pee

-BPO: benign prostate obstruction: may cause acute urinary retention + get chronic overfilling of bladder/lose normal fxn

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9
Q

Where is the prostate located

A

organ encircling the part of the urethra inferior to bladder

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10
Q

Fxn of the bladder

A

secrete the milky acidic shit to help sperm activate
- citrate: nutrient source
- PSA + proteolytic enzymes: liquefy coagulated sperm
- seminal plasmin: ABX protein
- relaxin: increase sperm motility

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11
Q

What are the 3 tissues that make up the prostate

A

stromal

epithelial

capsule: fibrous CT + SM

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12
Q

Fxn of the epithelial tissue in the prostate

A

glandular secretions

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13
Q

Which tissue contains the alpha-adrenergic receptors in the prostate

A

stromal tissue (contains about 70% of them)

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14
Q

T or F: BPH increases/predisposes someone to prostate cancer

A

F- impacts growth in different zones

BPH: central transition zone

cancer: proliferative zone

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15
Q

S+S of BPH

A

Obstructive SS
weak urine stream /slow flow
dribbling after peeing
straining to pee
occasional mid stream stoppage

Irritative SS
frequent urination
urge to urinate
leakage/overflow incontinence
frequent urination at night
urinary retention
UTI

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16
Q

What are the mandatory investigations that need to be done when looking into someone’s SS/ diagnosis of BPH

A

History
- medical conditions/trauma/surgeries
- Current Meds: anti-AcH, sympathomimetic agents

Urinalysis: rule out infection/look for blood

DRE: rule out cancer (want firm nontender prostate)

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17
Q

Recommended investigations to look into

A

Symptom survey scale: AUA or IPSS (how severe are symptoms)

Prostate Specific Antigen (PSA); measure before starting 5-alpha reductase inhibitor to get baseline

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18
Q

Optional Investigations for BPH

A

Serum Cr: high can be due to bladder obstruction

Urine cytology: screen for bladder cancer in men with hematuria/mostly irritative symptoms

Uroflow: peak flow rate < 15 —- obstruction

Voiding diary

Post-void residual (how much they leaving): concerning if > 200 (normal< 50)

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19
Q

Acronym to memorize symptoms

A

FUN WISE
- frequency, urgency, nocturia, weak stream, intermittency, straining, and emptying

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20
Q

T or F: high for the AUA or IPSS score is good + means symptoms are non severe

A

F- high is more severe

IPSS: asks same questions as AUA + Qs about QOL

Boyarsky Index: asks questions about obstructive symptoms + irritative symptoms

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21
Q

What is defined as mild BPH

A

AUA</=7
- generally asymptomatic, peak urinary flow rare of < 10, PVR > 25-50

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22
Q

Moderate BPH

A

same as mild + obstructive + irritative voiding symptoms

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23
Q

Severe BPH

A

Moderate shit + 1+ complications

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24
Q

Management approach for mild BPH

Study These Flashcards
A

watchful waiting

25
Management approach for severe BPH
refer for surgery
26
Treatment approach for someone with moderate BPH +ED
PDE5i, alpha adrenergic agent or BOTH
27
Treatment for moderate BPH + small prostate/low PSA
Not worried about prostate size itself —- symptoms: alpha adrenergic
28
Treatment for large prostate + BPH
5-alpha reductase + alpha adrenergic
29
Treatment management for moderate BPH if mostly irritative symptoms
alpha -adrenergic+ anticholinergic OR alpha adrenergic + mirabegron
30
What are complications of BPH
Acute + painful urinary retention that can lead to AKI Persistent or intermittent gross hematuria Overflow urinary incontinence or unstable bladder Recurrent UTIS Bladder diverticula or stones CKF
31
What are the 4 main drug class options
1) PDE 5 inhibitors —- vasodilators (work on vascular, bladder + prostate) 2) Anticholinergics/ M3 : causes SM relaxation in bladder to hold more etc (good for irritative) 3) Alpha-adrenergic : causes relaxation + increase urine flow in bladder + PROSTATE (not just good for irritative) 4) 5 alpha reductase: help decrease prostate size (decrease DHT levels)
32
When is watchful waiting appropriate
If pt has no symptoms or mild symptoms + no complications — basically have regular FU every 6-12 mths to ensure no progress - ask every time about symptoms + do objective tests (urinary flow rate, PVR urine V) - assess prostate size: DRE +/- PSA Education: restrict liquids before bed, decrease caffeine+ alcohol - go pee often avoid drugs that worsen it (BB and decongestants
33
3 main approaches to treat BPH
1) reduce dynamic factors/obstructive: change SM tone in prostate itself to help. pee (ex// alpha blocker) 2) Reduce static factors: change the prostate size to help (5-alpha reductases) 3) Improve bladder storage (irritative): relax detrusor muscle so bladder can hold more (anti-AcH, PDE5i, mirabegron)
34
MoA of Alpha-A Blockers
relax SM in bladder, prostate + urethra —— reduce dynamic factors so that urine can flow out
35
T or F: efficacy of the alpha blocker vary in the group
F- all equally with onset of 1-6 wks
36
What are the alpha-1 selective agents
SAT - silodosin: 8mg daily - alfuzosin: 10mg daily - tamsulosin: 0.4mg daily
37
Why do we prefer the alpha-1 selective agents to the non-alpha 1 selective blockers
non-selective: have more cardiac SEs (hypotension, syncope, palpitations) —- increase risk of first dose phenomenon
38
Non -alpha 1 selective agents
Doxazosin Prazosin Terazosin — all start with low dose + titrate up every 1-2 wks to prevent huge initial drop in BP
39
What is the first dose phenomenon
a huge fast drop in BP/syncope that can occurs first dose of alpha-adrenergic agents — also has tachycardia - greatest chance of occurring in non-selective agent
40
MoA: of 5-alpha reductase inhibitors
Static approach: target the prostate + the size itself - decrease conversion of test—-DHT to decrease prostate growth **not great for fast symptom relief
41
Efficacy of 5 alpha reductase inhibitors
onset 3-6mths - decrease prostate volume by 20-30% + decrease PSA levels by 50%
42
T or F: the main SE of 5 alpha reductase inhibitors is sexual dysfxn
T - also teratogenic ** dutasteride is also metabolized by CYP3A4 , do increase risk of drug levels if taken with inducer
43
Dosing for Dutasteride vs Finasteride for BPH
d: 0.5mg daily F: 5mg daily (vs AA - 1mg daily)
44
MoA: Anti-AcH agents
help with increasing bladder storage by relaxing bladder walls — good for irritative voiding symptoms CAN BE USED PRN onset 1-2wks
45
Who should not get Anti-AcH agents
old people —- increase risk of delirium
46
General SEs of Alpha adrenergic blockers
nasal congestion, headache, nausea, fatigue, drowsiness
47
AEs of anti-AcH agents
dry mouth, constipation + dry eyes
48
What specific SEs does tamsulosin have
retrograde ejaculation + floppy iris syndrome
49
Examples of Anti-AcH agents + dosing
Fesoterodine 4-8mg daily Darifenacin 7.5mg-15mg daily Also topical forms available if oxybutynin (patch, gel)
50
MoA: PDE5 inhibitors
increase bladder storage via relaxing SM in bladder ( vasodilator)
51
T or F: Sildenafil is the only PDE5i approved for BPH
F- Tadalafil bc can be dosed daily —- 5mg once daily for BPH onset: 4 wks
52
MoA: Mirabegron
Increase bladder storage/reduce emptying of bladder - beta 3 adrenergic agonist (relaxes bladder + increases time bw pees) — good for irritative SS normally 25mg daily (up to 50mg) - onset 2-8wks
53
What is the main SE to monitor/watch for with mirabegron
HTN
54
What is Desmopressin + what does it do
synthetic replacement of endogenous anti-diuretic hormone (stop us from peeing/ making lots of pee) —— increases water absorption in DCT +CD in the kidney (decrease urine production)
55
When is desmopressin helpful in BPH
Problematic nocturia
56
What to monitor when on desmopressin
Na levels—- causes hypo
57
What is the gold standard of surgical options for BPH
prostatectomy: remove that shit - Transurethral procedure (TURP): small + pull out via urethra - Open surgical: use if prostate too large (> 80)
58
What are the other surgical options
Transurethral incision of the prostate (TUIP): remove part of the prostate not whole Minimally invasive surgical procedures

IPFC-3 VTE+ Men’s Health (10 decks)

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