Benign Prostatic Hyperplasia Overview
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Questions and Answers

What is BPH?

Benign prostatic hyperplasia

BPH is a type of cancer.

False

What is the size of the prostate in relation to something else?

About the size of a walnut

Where are benign hypertrophic changes generally found in the prostate?

<p>Inner zone</p> Signup and view all the answers

Prostatic hypertrophy is directly related to the aging process and hormone activity.

<p>True</p> Signup and view all the answers

What is the name of the hormone that is converted to DHT?

<p>Testosterone</p> Signup and view all the answers

What is the name of the enzyme that converts testosterone to DHT?

<p>5a-reductase</p> Signup and view all the answers

DHT is less potent than testosterone.

<p>False</p> Signup and view all the answers

DHT stimulates growth factors that influence cell division, leading to prostatic hyperplasia and enlargement.

<p>True</p> Signup and view all the answers

What does BPH lead to when the prostate enlarges?

<p>Urethral compression and bladder outflow obstruction (BOO)</p> Signup and view all the answers

What are the symptoms of BPH referred to as?

<p>Lower urinary tract symptoms (LUTSs)</p> Signup and view all the answers

All men who experience LUTSs have BPH

<p>False</p> Signup and view all the answers

What are some other aetiologies for LUTSs?

<p>Stones</p> Signup and view all the answers

A histological diagnosis of BPH means the patient will definitely suffer from LUTSs.

<p>False</p> Signup and view all the answers

What are the two main types of LUTSs?

<p>Irritative</p> Signup and view all the answers

What are the causes of Irritative LUTSs?

<p>Failure of urine storage</p> Signup and view all the answers

What are the causes of Obstructive LUTSs?

<p>Failure to empty the bladder</p> Signup and view all the answers

Which of these are Irritative LUTSs symptoms?

<p>Urgency and urge incontinence</p> Signup and view all the answers

Which of these are Obstructive LUTSs symptoms?

<p>Post-micturition dribble</p> Signup and view all the answers

Most men over the age of 50 years exhibit some of the symptoms of BPH.

<p>True</p> Signup and view all the answers

What are the treatment options for BPH?

<p>All of the above</p> Signup and view all the answers

What are the principal treatment options for BPH?

<p>a-adrenoceptor blocking drugs, 5a-reductase inhibitors and combination therapy</p> Signup and view all the answers

Phytotherapy is a proven treatment for BPH.

<p>False</p> Signup and view all the answers

What is the dominant receptor in the prostate?

<p>α1A</p> Signup and view all the answers

α-adrenoceptor antagonists can potentially reverse the increase in sympathetic tone.

<p>True</p> Signup and view all the answers

α-adrenoceptor antagonists have a comparable side-effect profile.

<p>True</p> Signup and view all the answers

What are some side effects associated with α-adrenoceptor antagonists?

<p>Fatigue</p> Signup and view all the answers

Patients with BPH frequently experience erectile dysfunction.

<p>True</p> Signup and view all the answers

The treatment of BPH should aim to improve sexual function.

<p>True</p> Signup and view all the answers

The effect of a1-adrenoceptor antagonists on sexual function is consistent.

<p>False</p> Signup and view all the answers

What was the first a1-blocker used to relieve BPH symptoms?

<p>Prazosin</p> Signup and view all the answers

Prazosin is highly selective for a1A receptors.

<p>False</p> Signup and view all the answers

What are some adverse effects of Prazosin?

<p>All of the above</p> Signup and view all the answers

What was the first drug in its category to be evaluated in controlled trials for BPH?

<p>Terazosin</p> Signup and view all the answers

Terazosin has a consistent efficacy regardless of dosage.

<p>False</p> Signup and view all the answers

Adverse effects of Terazosin are generally mild.

<p>True</p> Signup and view all the answers

Doxazosin has a short half-life.

<p>False</p> Signup and view all the answers

Doxazosin is available in both immediate-release and controlled-release forms.

<p>True</p> Signup and view all the answers

Tamsulosin is a non-selective inhibitor of the alAand a1B-adrenoceptor.

<p>False</p> Signup and view all the answers

Tamsulosin is available as an extended-release formulation.

<p>True</p> Signup and view all the answers

Tamsulosin requires dosage titration during treatment.

<p>False</p> Signup and view all the answers

IFIS is caused by tamsulosin's high selectivity for the iris dilator muscle.

<p>True</p> Signup and view all the answers

Patients should inform their cataract surgeon about taking tamsulosin before surgery in case of potential IFIS.

<p>True</p> Signup and view all the answers

Alfuzosin has a shorter half-life than Tamsulosin.

<p>True</p> Signup and view all the answers

Alfuzosin is available only as a once-daily formulation.

<p>False</p> Signup and view all the answers

Alfuzosin has the least effect on ejaculatory function.

<p>True</p> Signup and view all the answers

Alfuzosin should be co-administered with potent inhibitors of cytochrome P450 3A4.

<p>False</p> Signup and view all the answers

What is the primary androgen responsible for BPH development and progression?

<p>DHT</p> Signup and view all the answers

There is only one type of 5α-reductase.

<p>False</p> Signup and view all the answers

Type 1 5α-reductase is predominant in genital tissue.

<p>False</p> Signup and view all the answers

What is the mechanism of action for 5α-reductase inhibitors?

<p>They block the conversion of testosterone to DHT.</p> Signup and view all the answers

What are the two agents currently available in the 5α-reductase inhibitor category?

<p>Finasteride and dutasteride</p> Signup and view all the answers

5α-reductase inhibitors have been shown to reduce prostate volume.

<p>True</p> Signup and view all the answers

5α-reductase inhibitors can increase the incidence of complications such as acute urinary retention.

<p>False</p> Signup and view all the answers

5α-reductase inhibitors primarily target the acute symptoms of BPH.

<p>False</p> Signup and view all the answers

Improvements in LUTSs from 5α-reductase inhibitors are typically seen within a month of treatment.

<p>False</p> Signup and view all the answers

What type of 5a-reductase inhibitor is finasteride?

<p>Type 2</p> Signup and view all the answers

Finasteride can reduce prostate size by around 50%.

<p>False</p> Signup and view all the answers

Men with prostates larger than 40mL are likely to benefit most from finasteride.

<p>True</p> Signup and view all the answers

What are some side effects of finasteride?

<p>All of the above</p> Signup and view all the answers

α-adrenoceptor antagonists are more effective than 5α-reductase inhibitors for managing acute BPH symptoms.

<p>True</p> Signup and view all the answers

5α-reductase inhibitors are more effective than α-adrenoceptor antagonists for reducing prostate size.

<p>True</p> Signup and view all the answers

Combination therapy for BPH is not typically recommended by medical professionals.

<p>False</p> Signup and view all the answers

Combination therapy is more effective than dutasteride in reducing AUR and progression to BPH-related surgery.

<p>False</p> Signup and view all the answers

Combination therapy has few adverse effects.

<p>True</p> Signup and view all the answers

Surgical interventions are the first line of treatment for BPH symptoms.

<p>False</p> Signup and view all the answers

Surgery is indicated for intractable or recurrent urinary retention related to BPH.

<p>True</p> Signup and view all the answers

BPH is a condition that is only commonly found in older men.

<p>True</p> Signup and view all the answers

Study Notes

Benign Prostatic Hyperplasia (BPH)

  • BPH is a common condition affecting men over 50, marked by non-cancerous prostate enlargement.
  • This enlargement surrounds the urethra, the tube carrying urine out of the body, and often causes urinary flow difficulties.
  • The prostate has glandular and fibromuscular parts, and different zones may cause different conditions.
  • Benign hypertrophic changes frequently happen in the inner zone, while malignancies often originate in the peripheral zone.
  • Hormonal activity, particularly the conversion of testosterone to dihydrotestosterone (DHT), plays a crucial role in stimulating prostate growth and enlargement.
  • DHT is five times stronger than testosterone, thus is predominantly responsible for growth factor influence on cell division leading to BPH.
  • Enlargement compresses the urethra, leading to bladder outflow obstruction (BOO) and lower urinary tract symptoms (LUTSs).

Pathophysiology

  • The prostate surrounds the urethra at the base of the bladder, comparable in size to a walnut.
  • The inner zone of the prostate is encapsulated by an outer layer.
  • Most malignant changes originate in the peripheral zone.
  • Prostatic hypertrophy is directly linked to aging and hormonal activity.

Symptoms

  • BPH does not necessarily cause symptoms in all men who have it.
  • Symptoms, when present, can range from mild to severe, impacting quality of life.
  • Lower urinary tract symptoms (LUTSs), often stem from bladder obstruction, and include types of storage and voiding issues.
  • Irritative symptoms include frequency, nocturia (frequent urination during the night), and urgency, incontinence.
  • Obstructive symptoms involve: difficulty initiating urination (hesitancy), poor urinary flow, post-micturition dribble, sensation of incomplete bladder emptying, and occasionally acute retention (requiring treatment).
  • Other causes of LUTSs can be bladder cancer, kidney stones, urinary tract infections (UTIs), or urethral strictures.

Treatment

  • Treatment options range from medical therapy to surgery, based on individual symptom severity and the presence of complications.
  • Medical therapies include alpha-adrenoceptor blocking drugs (e.g., prazosin, terazosin, doxazosin, alfuzosin), 5α-reductase inhibitors (e.g., finasteride, dutasteride), or a combination of both.
  • Surgical interventions are considered for men with BPH experiencing complications like acute urinary retention, renal impairment, hematuria (blood in the urine), or frequent UTIs.
  • Alpha-adrenoceptor blocking drugs are useful for managing BPH symptoms but offer no benefit toward preventing complications and progression to surgery.
  • 5-alpha reductase inhibitors reduce the prostate size, improve urinary flow, and are more often suited for patients with large prostates.

Alpha-Adrenoceptor Blocking Drugs

  • These drugs typically reduce bladder outlet obstruction and may improve symptoms in men with BPH.
  • Alpha-1A adrenoceptors are the primary target in the prostate and typically mediate smooth muscle contraction.
  • However, subtypes alpha-1B and alpha-1D receptors have also been identified within the prostate.
  • While efficacy data suggests alpha-1A is the dominant receptor, further clinical confirmation is still necessary.
  • Various drugs like prazosin, terazosin, doxazosin, and alfuzosin are available.

5α-Reductase Inhibitors

  • Finasteride and dutasteride effectively block the conversion of testosterone to DHT, a factor key in BPH development.
  • They reduce prostate volume and improve urinary flow.
  • Effectiveness is primarily assessed by the impact on prostate volume and flow, particularly in men with prostate size larger than 40ml.
  • Side effects, though infrequent, should be considered, including decreased libido, impotence, and, less often, gynecomastia (breast growth) and breast tenderness.

Combination Therapy

  • Combining alpha-adrenoceptor blockers and 5α-reductase inhibitors might offer additional benefits over using either treatment alone.
  • This approach is often used to manage complications and progression toward BPH-related surgery.
  • Despite the reduction of acute urinary retention and BPH-related surgery, combination therapy may not lead to a significantly better outcome compared to dutasteride in terms of symptom management.

Surgical Treatments

  • Surgical procedures are typically reserved for patients with BPH in the event that medical therapies cannot effectively manage symptoms.
  • Surgery is often undertaken for persistent acute retention or other associated complications like recurrent urinary infections, renal impairment, persistent hematuria, or bladder stones.

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Benign Prostatic Hyperplasia PDF

Description

This quiz delves into Benign Prostatic Hyperplasia (BPH), a common condition among men over 50 characterized by non-cancerous enlargement of the prostate. Learn about its causes, effects on urinary flow, and the role of hormones like DHT in prostate growth. Test your knowledge of the pathophysiology and related symptoms of this condition.

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