Benign Prostatic Hyperplagia

What are the scores for the AUA?

0-7 Mild 8-19 Moderate 20-35 Severe

What are the two main drugs classes used to treat BPH?

1. 5a-reductase inhibitors 2. a-adrenergic receptor blockers

What are the risk factors for BPH? (9)

1. Aging 2. Obesity (especially waist circumference) 3. Lack of physical activity 4. A high amount of dietary animal protein 5. Alcohol use 6. ED 7. Smoking 8. Diabetes 9. Family Hx in a first-degree relative may also be a risk factor

What would we look for as possible indicators of BPH in a urinalysis or urine culture?

1. Bacteria 2. Nitrites 3. Leukocyte esterase 4. WBC's 5. RBC's

What are obstructive symptoms of BPH? (4)

1. Decrease in the caliber and force of urinary stream 2. Difficulty in starting a stream 3. Intermittancy (starting and stopping the stream) 4. Dribbling at the end of urination

What two categories can symptoms of BPH be divided into?

1. Irritative 2. Obstructive

What are irritative symptoms of BPH? (6)

1. Nocturia 2. Urinary frequency 3. Urgency 4. Dysuria 5. Bladder pain 6. Incontinence

What are the goals of Interprofessional care?

1. Restore bladder drainage 2. Relieve the patient's symptoms 3. Prevent or treat the complications of BPH

What are some alternatives to surgery with BPH? (3)

1. Surveillance 2. Drug Therapy 3. Minimally Invasive Procedures

What are some of the complications of BPH?

1. Urinary retention 2. UTI 3. Pyelonphritis (UTI travels to the kidneys) 4. Bladder Stones (Caused by urinary obstruction) 5. Renal failure (caused by Hydronephrosis)

What is Jalyn?

A combination drug of dutasteride (5a- reductase inhibitor) and tamsulosin (a-adrenergic receptor blocker)

What diagnostic test is done to estimate the prostate size, symmetry, and consistency?

A digital rectal exam (DRE)

What would a DRE find in a patient with BPH?

A prostate that is symmetrically enlarged, firm, and smooth

What is Uroflowmetry?

A study that measures the volume of urine expelled from the bladder, is helpful to determine the extent of urethral blockage and the type of treatment needed

What is the most conservative treatment that is recommended for some patients with BPH?

Active surveillance, or watchful waiting. This takes place when the patient has mild symptoms (AUA scores 0-7)

What does a transrectal ultrasound (TRUS) do?

Allows for accurate assessment of prostate size, and can help distinguish BPH from prostate cancer

Why might we perform a neurological exam on someone with BPH?

Because symptoms of BPH are similar to that of a neurogenic bladder

What is BPH?

Benign Prostatic Hyperplagia is a condition in which the prostate gland increases in size, disrupting the outflow of urine from the bladder to the urethra

What is a prostate-specific antigen test (PSA)?

Blood test to screen for prostate cancer

What is Hydronephrosis?

Distention of the renal pelvis and calyces by urine that can not flow through the ureter to the bladder

Why should women not handle finasteride (proscar) without gloves?

Due to potential risk to male fetus anomly

How do manifestations develop in BPH?

Gradually, early symptoms may not cause problems because the bladder can compensate for a small amount of resistance to urine flow

How is Dutasteride (Avodart) different from Finasteride (Proscar)?

Has the same effect on prostatic tissue, but is a dual inhibitor of type 1 and type 2 isoenzymes

If creatinine levels are high in a patient with BPH, would might we suspect?

Hydronephrosis

Why would we use cytoscopy in diagnosing BPH?

If the diagnosis is unclear, or to see the degree of prostatic enlargement

What are irritative symptoms usually caused by?

Inflammation or infection

What is particular about Finasteride (Proscar)?

Inhibits only the type 2 isoenzyme, and is an appropriate treatment option for men who have a moderate to severe symptom score on the AUA. Can take up to 6 months to be effective, must be taken on a regular basis to have an effect.

What is the treatment include for patients on active surveillance?

Lifestyle changes to help relieve early or mild symptoms: 1. decreasing intake of bladder irritants 2. avoiding certain drugs (decongestants, anticholinergics) 3. restricting evening fluids 4. Timed voiding schedule

What are irritative and obstructive symptoms collectively known as?

Lower Urinary Tract Symptoms (LUTS)

Does BPH cause prostate cancer?

No, BPH does not cause or lead to prostate cancer

What is the first symptom most patients notice of BPH?

Nocturia

How would BPH show up in a PSA test?

PSA levels may be slightly increased

Why would we order a transrectal ultrasound (TRUS)?

Patient had an abnormal DRE and a high PSA level

What volume can determine the degree of urine flow obstruction?

Postvoid residual urine volume

What are obstructive symptoms of BPH caused by?

Prostate enlargement

What levels can be effected by Finasteride?

Serum PSA levels may appear to decrease by almost 50%

In which "zone" of the prostate does BPH develop?

The transition zone

How do a-adrenergic receptor blockers work on BPH?

They offer symptom relief by relaxing the smooth muscle of the prostate that surrounds the urethra, thus facilitating urine flow

What is treatment for BPH based on?

Usually based on the degree to which the symptoms bother the patient, or the presence of complications rather than the size of the prostate

What causes BPH?

We think, that hormonal changes associated with aging are a contributing factor. As men age, they have a decrease in testosterone, but continue to make and accumulate high levels of Dihydroxytestosterone (DHT), which leads to prostate enlargement. Other theories point to an increased proportion of estrogen, that increases activities of substances (like DHT) that promote prostate cell growth.

What do 5-a reductase inhibitors do?

Work by reducing the size of the prostate gland by blocking 5a-reductase type 1 and type 2 isoenzymes which are necessary for the conversion of testosterone into DHT