Benign Prostatic Hyperplasia Quiz
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Questions and Answers

What is the approximate weight of the prostate gland?

  • 30 grams (correct)
  • 70 grams
  • 50 grams
  • 10 grams

    • What is the main cause of lower urinary tract symptoms (LUTS) in men over 80 years old?

  • Benign prostatic enlargement (BPE) (correct)
  • Urinary tract infection
  • Prostate cancer
  • Kidney stones

    • The International Prostate Symptom Score (IPSS) is a questionnaire used to assess:

  • Prostate cancer risk
  • Erectile dysfunction
  • Lower urinary tract symptoms (LUTS) (correct)
  • Prostate gland size

    • What does the abbreviation 'BOO' stand for in the context of BPE?

    <p>Bladder Outlet Obstruction (B)</p> Signup and view all the answers

    Which of the following is NOT a lobe of the prostate gland?

    <p>Superior (A)</p> Signup and view all the answers

    What is the histological abnormality that underlies benign prostatic enlargement (BPE)?

    <p>Benign prostatic hyperplasia (BPH) (D)</p> Signup and view all the answers

    What does the prostate gland produce?

    <p>Ejaculate containing enzymes, zinc, and other fluids (D)</p> Signup and view all the answers

    What is the primary function of the prostate gland in relation to the urinary system?

    <p>Surrounds the urethra and helps control urine flow (A)</p> Signup and view all the answers

    What type of growth does BPH refer to in the prostate?

    <p>Nonmalignant growth (B)</p> Signup and view all the answers

    Which age-related factor is most commonly associated with BPH?

    <p>Age as a risk factor (B)</p> Signup and view all the answers

    What is the metabolite of testosterone that plays a significant role in BPH?

    <p>Dihydrotestosterone (DHT) (A)</p> Signup and view all the answers

    How do androgens influence prostatic cell turnover?

    <p>By actively inhibiting cell turnover (A)</p> Signup and view all the answers

    What lifestyle factor is associated with a reduced risk of developing BPH?

    <p>Moderate to vigorous physical activity (D)</p> Signup and view all the answers

    Which receptor type is predominantly found in prostatic smooth muscle cells?

    <p>Alpha-adrenergic receptors (A)</p> Signup and view all the answers

    What is the relationship between BPH and cardiovascular disease?

    <p>Possible pathophysiologic relationship (D)</p> Signup and view all the answers

    What physiological characteristic is linked to the development of BPH?

    <p>Persistence of DHT levels with aging (D)</p> Signup and view all the answers

    What type of symptoms are primarily associated with bladder outlet obstruction in BPH?

    <p>Voiding/emptying symptoms (A)</p> Signup and view all the answers

    Which of the following is NOT an essential component of diagnosing BPH?

    <p>Blood pressure measurement (D)</p> Signup and view all the answers

    What symptom is characterized by the feeling of not being able to completely empty the bladder?

    <p>Sensation of incomplete emptying (C)</p> Signup and view all the answers

    Which test is performed to assess bladder outlet obstruction by measuring urine flow?

    <p>Uroflowmetry (A)</p> Signup and view all the answers

    What is a common filling/storage symptom of BPH?

    <p>Nocturia (A)</p> Signup and view all the answers

    Which of the following indicates a need for therapy in BPH?

    <p>Recurrent urinary retention (A)</p> Signup and view all the answers

    Which specific volume of residual urine is considered the lower threshold to define abnormal in bladder outlet obstruction?

    <p>50 to 100 mL (D)</p> Signup and view all the answers

    Which diagnostic score is standardized to assess symptoms of BPH?

    <p>American Urological Association Symptom Score (AUASS) (A)</p> Signup and view all the answers

    Which pharmacotherapy combines finasteride and tamsulosin?

    <p>Combined therapy (D)</p> Signup and view all the answers

    Which of the following is a method under non-pharmacological therapy?

    <p>Transurethral microwave thermotherapy (C)</p> Signup and view all the answers

    What is one of the parameters monitored in patients undergoing treatment for LUTS?

    <p>Quality-of-life indices (C)</p> Signup and view all the answers

    Which of the following is NOT classified as a complementary and alternative medicine (CAM) for LUTS?

    <p>Transurethral needle ablation (C)</p> Signup and view all the answers

    What is the purpose of 5-alpha reductase inhibitors like finasteride?

    <p>To reduce the size of the prostate (D)</p> Signup and view all the answers

    Which surgical method is included as a minimally invasive option for LUTS treatment?

    <p>Prostatic urethral lift (PUL) (A)</p> Signup and view all the answers

    Which monitoring outcome indicates improvement in therapy for LUTS?

    <p>Reduction in symptom scores (B)</p> Signup and view all the answers

    What does therapeutic concordance refer to in the context of LUTS treatment?

    <p>Patient adherence to treatment plans (D)</p> Signup and view all the answers

    Flashcards

    Benign Prostatic Hyperplasia (BPH)

    A histological abnormality leading to benign prostatic enlargement.

    Lower Urinary Tract Symptoms (LUTS)

    Symptoms such as difficulty urinating, often associated with BPE.

    Benign Prostatic Enlargement (BPE)

    Common enlargement of the prostate affecting many older men.

    International Prostate Symptoms Score (IPSS)

    A questionnaire to assess the severity of urinary symptoms.

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    Prostate Volume (PV)

    Measurement of the prostate size, assessed via ultrasound.

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    Bladder Outlet Obstruction (BOO)

    Blockage at the base of the bladder preventing urination.

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    Therapeutic Goals in BPH

    Setting objectives for medication choice and outcomes prediction.

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    Non-Pharmacological Interventions

    Therapeutic options besides medications for BPH management.

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    BPH

    Benign prostatic hyperplasia, a nonmalignant growth of the prostate.

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    Androgens

    Hormones necessary for the development of BPH, primarily testosterone and its metabolite DHT.

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    5α-reductase

    An enzyme that converts testosterone into dihydrotestosterone (DHT), significant in BPH.

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    DHT

    Dihydrotestosterone, an active metabolite of testosterone that causes prostate cell proliferation.

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    Age

    The most significant risk factor associated with BPH development.

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    Sedentary lifestyle

    A lifestyle factor that can increase the risk of developing BPH; active individuals have lower risk.

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    Prostatic smooth muscle

    Muscle in the prostate that contains many α-adrenergic receptors and is significant for prostate function.

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    Inflammation

    A linked factor in the development of both BPH and prostate cancer.

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    α1-adrenergic mediation

    Contraction of the prostate and bladder neck is controlled by α1-adrenergic receptors.

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    Voiding symptoms

    Symptoms during urination like hesitancy and weak flow.

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    Filling symptoms

    Symptoms experienced when the bladder fills, like urgency and nocturia.

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    Prostate enlargement signs

    Detectable increase in prostate size seen in exams or images.

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    Digital Rectal Exam (DRE)

    A physical examination to assess prostate size and abnormalities.

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    Residual urine volume

    Amount of urine left in the bladder after voiding, abnormal if >50-100 mL.

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    Uroflowmetry test

    Measures urine flow rate to assess for obstruction.

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    Indications for therapy

    Conditions that necessitate treatment, like urinary retention or azotemia.

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    Alpha-adrenergic Antagonists

    Medications that block alpha-adrenergic receptors, helping relieve LUTS.

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    5-alpha Reductase Inhibitors

    Medications that inhibit the enzyme responsible for converting testosterone, reducing prostate size.

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    Combined Therapy

    Using both finasteride and tamsulosin to treat LUTS.

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    Anticholinergic Agents

    Medications that block certain neurotransmitters, used for urinary symptoms, like oxybutynin.

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    Phytotherapeutic Preparations

    Plant-based treatments used in CAM for LUTS, such as saw palmetto.

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    Non-Pharmacological Therapy

    Treatment methods for LUTS that do not involve medications.

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    Therapeutic Concordance

    The agreement between a patient and provider on treatment goals.

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    Monitoring Outcomes

    Evaluating treatment effectiveness using symptom scores and quality of life indices.

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    Study Notes

    SOPH 411: Pathophysiology and Therapeutics II (Benign Prostatic Hyperplasia - BPH)

    • Benign prostatic enlargement (BPE) is common, with approximately half of men aged 80 and over exhibiting lower urinary tract symptoms (LUTS) related to bladder outlet obstruction (BOO).
    • BPE is caused by benign prostatic obstruction (BPO).
    • A prospective cross-sectional community study in Ghana on 111 men, aged 40–80 years old, noted high degrees of prostate-related LUTS.
    • LUTS prevalence among the study subjects was 42.3% for IPSS and 27.0% for IPSS + PV.
    • Benign prostatic hyperplasia (BPH) is a non-malignant growth of prostate stroma and epithelial glands, leading to prostate enlargement and underlying histological changes.
    • BPH is referred to as hyperplasia, benign prostatic hypertrophy, adenomatous hypertrophy, and glandular hyperplasia, and stromal hyperplasia.
    • Age is a key risk factor
    • Sex steroid hormones, specifically an increase in serum dihydrotestosterone (DHT) levels
    • Genetics contribute to larger prostate volume and earlier onset of BPH
    • Metabolic syndrome (MS) is linked to elevated C-reactive protein (CRP) levels and potential links to intraprostatic factors.
    • Cardiovascular disease and hypertension may have a pathophysiologic relationship with BPH.
    • Diabetes and alterations in glucose homeostasis correlate with increased prostate volume.
    • Lipids are potentially linked to BPH, particularly in relation to obesity and MS, though this is a complex and debated relationship.
    • Alcohol and smoking are controversial factors in BPH causation.
    • Sedentary lifestyles may increase the risk of BPH, while moderate to vigorous physical activity potentially reduces the risk.
    • Inflammation is linked to BPH and prostate cancer development.
    • Race is a controversial factor influencing prostate disease but some evidence exists.

    Pathophysiology - BPH

    • The development of BPH requires testicular androgens alongside the aging process
    • Those castrated before puberty, or have impaired androgen production/action are unlikely to develop BPH.
    • The prostate maintains androgen responsiveness throughout life, impacting cell proliferation and differentiation.
    • Androgens can actively inhibit cell turnover and death.
    • Dihydrotestosterone (DHT), an active metabolite of testosterone, plays a critical role in prostate growth, and its activity directly correlates to 5a-reductase enzyme.
    • Two types of 5α-reductase (type 1 and type 2) have been identified.
    • In stromal cells, DHT plays an autocrine and paracrine role, influencing nearby epithelial cells through diffusion.
    • Prostatic cells contain many androgen receptors, and DHT levels remain high with aging, even with lower peripheral levels.
    • DHT is produced both peripherally by type 1 and type 2 5α-reductase enzymes.

    Prostate Anatomy

    • The prostate gland is walnut-shaped and approximately 30 grams in weight
    • The prostate gland has five lobes: anterior, posterior and two lateral, and one median lobe.
    • It's located below the bladder, at the base of the penis, in front of the rectum, and surrounds the urethra.
    • The ejaculate, produced by the prostate, contains enzymes, zinc, and citric acid to nourish sperm.

    Symptoms of BPH

    • Voiding/emptying symptoms:
    • Reduced size and force of the urinary stream
    • Hesitancy or straining to void
    • Intermittent or interrupted flow
    • Sensation of incomplete bladder emptying
    • Terminal dribbling
    • Filling/storage symptoms:
    • Nocturia (frequent urination at night)
    • Daytime frequency
    • Urgency
    • Urgency incontinence

    Signs of BPH

    • Detectable anatomical enlargement of the prostate during physical exam or imaging.
    • Secondary bladder changes from obstruction may occur.
    • Upper urinary tract changes, including ureterectasis, hydroureter, and/or hydronephrosis can potentially develop.

    Diagnosis of BPH

    • Essentials of diagnosis:
    • Detailed patient history
    • Digital rectal exam
    • Physical exams targeting the prostate
    • Urinalysis
    • Additional diagnostic tools:
    • Serum creatinine
    • Renal ultrasound (if serum creatinine abnormal)
    • Standardized symptom assessment tools (AUASS and IPSS)
    • Other diagnostic components:
    • Digital rectal examination (DRE)
    • AUA symptom index, assessing symptoms over the previous month (0 to 35 points)
    • Measurement of post-void residual urine volume (PVR)
    • Uroflowmetry in assessment of bladder outlet obstruction (BOO).

    Indication for BPH treatment

    • Refractory or recurring urinary retention
    • Azotemia related to BPH
    • Significants recurrent gross hematuria
    • Recurrent or residual urinary infection
    • Large, unreduced residual urine volume

    Therapeutic Goals of BPH Treatment

    • Managing bothersome symptoms influencing the quality of life experienced by patients.

    Pharmacotherapy for BPH

    • Alpha-adrenergic antagonists: Tamsulosin
    • 5-alpha reductase inhibitors: Finasteride
    • Combined therapy: Finasteride plus tamsulosin
    • Anticholinergic agents: Oxybutynin

    Non-pharmacological therapies for BPH

    • Minimally Invasive: transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), water vapor thermal therapy, prostatic urethral lift (PUL), transurethral electrosurgical incision of the prostate (TUIIP)
    • Surgical: simple prostatectomy, transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HOLEP),thulium laser enucleation of the prostate (Thul FP).

    Monitoring and Outcomes of BPH Treatment

    • Evaluating symptoms and symptom scores
    • Monitoring quality of life indicators
    • Verifying correction of sequelae, like azotemia.
    • Assessing urodynamic indices
    • Measuring prostate size (crucial for bulk reducing therapies)
    • Evaluation of treatment effectiveness on the natural history of the disease.
    • Assessing adverse events and expenses related to the treatment.

    Complementary and Alternative Medicine (CAM) for BPH

    • Saw palmetto plant (Serenoa repens)
    • Stinging nettle (Urtica dioica)
    • Prostacure tea is categorized as a CAM therapy

    Discussion and Counselling

    • Therapeutic concordance and counselling sessions are essential for navigating treatment decisions with patients.
    • Health promotion counselling for BPH treatment are important topics for patient education.

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    SOPH 411: Pathophysiology and Therapeutics II (BPH) PDF

    Description

    Test your knowledge on Benign Prostatic Hyperplasia (BPH) with this quiz! Explore topics such as prostate anatomy, symptoms, causes, and histological aspects related to BPH. This quiz is ideal for students in medical or healthcare courses.

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