PBL 1 Flashcards
outline the pathophysiology behind the cell proliferation in benign prostatic hyperplasia?
oestrogens and androgens enter cells and bind to receptors in the nucleus to inhibit apoptosis and akkow lumen and basal cells within the prostate to proliferate. After the age of 30 decrease but 5 alpha reductase levels increase so we got more formation of dihydrotestosterone which is 10x more potent than hyprplasia and therefore causes hyperplasia.
what causes the narrowing of the urethral canal in BPH?
the enlargement of the prostate squeezing on it and the formation of hyperplastic nodules in the periurethral zone.
how prevalent is BPH at the age of 90?
90%
what are some risk factors for BPH?
age >40 Fhx BPH heart and circulatory disease beta blocker use obesity diabetes type 2 lack of physical exercise erectile dysfunction
what are some complications of BPH?
bladder damage due to hypertrophy caused by urine in bladder making it dilate and smooth muscles contracting harder in response
urinary retention
UTIs due to post void residual volume becoming stagnant
hydronephrosis due to build up of urine
what are the signs and symptoms of BPH?
frequency, urgency, nocturia, dysuria, emptying bladder feels incomplete, difficulty starting and stopping urine flow, dribbling, weak stream
why would we do a digitial rectal exam in BPH?
to determine if the prostate is enlarged or nodular - in BPH it should feel enlarged, rubbery, like a bulge
what are blood tests done for in BPH?
to see if there is increases in prostate specific antigen, electrolytes, blood urea nitrogen and creatinine
why do we do urinanalysis in BPH?
Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
what imaging do we do in BPH?
transrectal ultrasound, cystoscopy, maybe MRI
what are some lifestyle changes you can do to relive BPH symptoms?
drink less caffeiene, drink less fluid in the evening, remember to empty your bladder, double voiding to try to help empty your bladder, check meds, eat more fibre, use pads and bladder training
what are the 6 classes of drugs used to treat BPH?
alphablockers PDE5 inhibitors anticholinergics 5 alpha reductase inhibitors diuretics desmopressins
how do alpha blockers work to reduce BPH?
they inhibit alpha adrenergic receptors on smooth muscle, stopping the constriction effects and allowing a decrease in resistance along bladder neck, prostate and urethra. This allows urine to pass through more easily
how do 5 alpha reductase inhibitors work for BPH?
they reduce the formation of dihydrotestosterone which prevents the proliferation of prostate tissue and improves the flow of urine
how do PDE5 inhibitors work?
they relax smooth muscle fibres of the bladder and prostate, improving flow
how do anticholinergics work to reduce BPH?
they relax the bladder muscle if its overactive
how do diuretics help in BPH?
they increase the amount of urine produced so if used in the day they can prevent chances of nocturia
how can desmopressins be used in BPH?
Desmopressins slow down urine production so less urine is produced at night.
what is a transurethral resection of the prostate?
a non-invasive surgical procedure cutting away sections of the prostate - note this is not permenant and prostate will grow back if androgen levels remain high
what is an open prostatectomy?
the surgical removal of the prostate gland
why dont we screen for PSA in the UK?
we dont believe the risks outweight the benefits…
- PSA tests are not sensiitive - PSA levels rise in bikers, after sexual intercourse, after catheter use
- 1/7 prostate cancer cases have normal PSA = not specific
- Test can show slow-growing cancer that will never affect the indidvidual - just worries them
- Treating early is beneficial but the side effects are so serious men often wait till its absolutely necessary
- Biopsies have risks of bleeding, infection and pain
what do we do instead of PSA screening in the UK?
there is an informed choice programme called prostate cancer risk management, for health men >50 who query their GP about PSA testing. It aims to give men good information on the pros and cons on the PSA test.
what is sensitivity?
the chance a test can detect a specific disease in people who have that disease
true positives / total diseased
what is specificty?
the chance a test can detect negative results for a specific disease in people who dont have the disease
true negatives / total non-diseased
