Benign Prostatic Hyperplasia

Question 1

Quick overview of the prostate:

7

Answer 1

• Surrounds the urethra
• Located directly inferior to the bladder
• Accessory organ
• Encapsulated
• Neoplasia is common
• In contact with the rectum
• Exocrine gland
  
  • Secretes prostatic fluid

Question 2

What is the most common reproductive disorder in men?

Answer 2

Benign prostatic hyperplasia

Question 3

Enlargement of the prostate is _____ and begins ____________.

Answer 3

• Slow

- Periurethral

Question 4

T or F:

Benign prostatic hyperplasia occur with, but not due to, ageing.

Answer 4

T

• Above 40yrs ~20%
• Above 60yrs ~50%
• Above 80yrs ~90%

Question 5

What is the Et of benign prostatic hyperplasia?

Answer 5

• Unclear
• # 1 risk is ageing
• Hormonal factors
• Genetics
• Race
  
  • Africans have high risk
  • Japanese have low risk, may r/t yellow veggie diet
• Diet
  
  • High yellow vegetable content in diet decrease risk

Question 6

How is testosterone converted to dihydro-testosterone?

Answer 6

By 5alpha-reductase in the prostate

Question 7

What is the role of dihydro-testosterone is normal prostate Fx?

Answer 7

Supports growths, development, and Fx of the prostate

Question 8

In order for dihydro-testosterone to have an effect on the prostate, what must happen first?

Answer 8

The prostate cells must be sensitized by estrogen

Question 9

T or F:

Testosterone and estrogen levels decrease significantly with age.

Answer 9

F, the testosterone decreases but estrogen remains relatively the same

Question 10

With age there is a relative increase in estrogen due to the decrease of testosterone, how does this contribute to benign prostatic hyperplasia?

Answer 10

The estrogen begins to oversensitize the prostatic cells to dihydro-testosterone, this contributes to the excessive growth and proliferation of cells

Question 11

How does prostatic IGF contribute to benign prostatic hyperplasia?

Answer 11

I don’t know…it just does somehow…

Question 12

How is urine flow impeded by benign prostatic hyperplasia?

Answer 12

The prostate directly impacts flow because the hyperplasia begins around the urethra and occupies some of its space. Does the hypertrophy of the smooth muscle in ducts somehow relate to this too?

Question 13

Impeded urine flow as a result of benign prostatic hyperplasia may result in urinary retention, if it does, how might this affect the bladder?

Answer 13

Causes structure changes in the bladder:
- Bladder wall thickens to prevent rupture
- Bladder develops trabeculations and diverticula to
increase capacity

Question 14

What happen to the ureters and the kidneys as a result of urinary retention?

Answer 14

• Hydroureter: distended ureters
  
  • Pressure is highest where ureters and bladder attach
  • “fish hook” ureters
• Hydronephrosis: distention of renal pelvis and calyces

Question 15

If urine pools in the kidneys (urine stasis) what can this cause?

Answer 15

Infection and the formation of calculi (kidney stones)

Question 16

What are the mnfts of benign prostatic hyperplasia?

5

Answer 16

• Frequency of voiding urine d/t incomplete emptying
• Hesitancy of voiding
• Weak urine stream d/t compression of urethra
• Terminal dribbling
• Urine retention

Question 17

Dx of benign prostatic hyperplasia?

5

Answer 17

• Mnfts
• Hx, Px
  
  • Digital rectal exam (screen)
• Prostate specific antigen testing (screen and Dx)
  
  • tPSA = Total mass, if increased indicates problem
  • PSAd = Density of prostate
  • PSAv = Velocity of cell growth
• BUN, creatinine
• Urinalysis
  
  • Kidney stones
  • CASTS (what is this?)

Question 18

What is the first approach to treating benign prostatic hyperplasia?

Answer 18

Behavioral changes

• Eliminate nocturia
  
  • Avoid fluids 1-2 hours before bed
• Avoid caffeine and alcohol

Question 19

What drugs are used to treat benign prostatic hyperplasia?

Answer 19

• 5a-reductase (long term)
• Alpha adrenergic antagonists
• Combination Tx is the most successful

Question 20

What are Sx options to treat benign prostatic hyperplasia?

Answer 20

• Transurethral resection of the prostate (TURP)

- Laser prostatectomy