Term
| Benign Prostatic Hyperplasia (BPH) |
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Definition
most common benign neoplasm in aging male;
Static: anatomic block due to enlarged prostate gland;
Dynamic: increased alpha-adrenergic stimulation --> decreases bladder emptying
Main Risk Factors: pt age, hormones;
Caused by increased growth of prostate after the age of 40 to much larger sizes |
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Term
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Definition
renal failure;
UTIs;
urinary incontinence;
bladder stones;
gross hematuria; |
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Term
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Definition
Obstructive Voiding Symptoms: decreased stream force, hesitancy, straining to void, incomplete emptying, dribbling, intermittency;
Irritative voiding: urgency, clothes wetting, dysuria, frequency, nocturia;
Silent: no symptoms |
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Term
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Definition
abnormal rectal exam: prostate is enlarged;
Post Void Residual (PVR) urine volume is >= 50 mL;
Peak & mean urine flow rates < 10-12 mL/sec;
Urinalysis - screen for UTIs; |
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Term
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Definition
asymptomatic;
AUA symptom score <=7;
Enlarged prostate on DRE;
Urine flow rate <10 mL/sec, PVR >25-50 mL; |
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Term
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Definition
bothersome symptoms;
AUA symptom score 8-19;
Enlarged prostate;
Urine flow rate <10 ml/sec;
PVR > 25-50 mL;
Obstructive + Irritative voiding symptoms; |
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Term
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Definition
bothersome symptoms;
AUA symptom score >=20;
Enlarged prostate;
Urine flow rate <10 ml/sec;
PVR > 25-50 mL;
Obstructive + Irritative voiding symptoms;
1 or more complications of BPH;
Elevated BUN & SCr |
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Term
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Definition
treatment option for pt who does not perceive Sx to be bothersome;
No specifici BPH tx initiated;
Followed at 3-6 month intervals, if pt displays progression of dx, switch to medical or surgery therapy |
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Term
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Definition
indicated for moderate/severe BPH without complications;
Begin w/ alpha-adrenergice antagonist OR a 5-alpha reductase inhibitor; |
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Term
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Definition
indicated for moderate/severe BPH w/ complications, for pts who cannot tolerate ADRs of medical therapy, noncompliance;
GOLD STANDARD = prostatectomy |
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Term
| 5-alpha reductase inhibitors |
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Definition
preferred in pts who cannot tolerate ADRs of alpha-adrenergic antagonists or in those w/ prostates > 40 g;
May be used in combo w/ alpha-adrenergic antagonists in pt w/ moderate/severe sx & at risk for complications of BPH;
reduces size of enlarged prostate;
halts dx progression;
3-6 months for onset of action;
NO cardiovascular effects;
Sexual: decreased libido, erectile dysfunction, ejaculatory disorders; |
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Term
| Alpha-Adrenergic Antagonists |
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Definition
1st line tx of moderate/severe BPH - rapid onset of action (1-6 wks), increased efficacy;
Relaxes prostate smooth muscle;
ADRs: cardiovascular
Sexual: ejaculation disorders |
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Term
| 2nd-Gen Alpha-1 Adrenergic Antagonists - terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral) |
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Definition
MoA: blocks stimulation of post-synaptic alpha-1 adrenergic receptors at bladder neck & prostatic stromal tissue --> decrease dynamic component of BPH;
Effective in relieving symptoms;
Dosing: Start at lowest available, give 1st dose at bedtime, titrate slowly to effective daily maintenance dose, increase dose at 1/2-1 wk intervals; |
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Term
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Definition
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Term
| doxazosin (Cardura, Cardura XL) |
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Definition
| IR & XR, both require titration |
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Term
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Definition
modified release, NO titration;
uroselective --> improves urinary symptoms & low potential for vascular side effects;
Drug conc. more in prostate tissue, fixed low daily dose is recommended; |
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Term
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Definition
modified release, Minimal titration required;
DRUG OF CHOICE for pts w/ moderate/severe sx who cannot tolerate hypotension;
Take each dose 30 min after same meal each day;
Food decreases absorption; |
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Term
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Definition
IR, NO titration required;
C/Is:
- CrCL <30 ml/min;
- use of CYP 3A4 inhibitors (ketoconazole, itraconazole, clarithromycin);
- use of potent P-glycoprotein inhibitors (ketoconazole) |
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Term
| ADRs of 2nd Gen Alpha-Adrenergic Antagonists |
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Definition
1st dose syncope;
Orthostatic hypotension;
tiredness, asthenia;
nasal congestion;
retrograde ejaculation |
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Term
| 3rd Gen Uroselective Alpha-1A Adrenergic Antagonists - tamsulosin (Flomax), silodosin (Rapaflo) |
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Definition
MoA: selectively anatagonizes Alpha-1A receptors, relaxes smooth muscle of prostate & bladder neck, minimally inhibits vascular alpha receptors;
Take anytime of day;
Equally effective as other alpha-adrenergic antagonist; |
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Term
| ADRs of 3rd Gen Uroselective Alpha-1A Adrenergic Antagonists |
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Definition
large doses: loss of receptor selectivity --> hypotension;
tiredness, asthenia, retrograd ejaculation;
- FLOPPY IRIS SYNDROME |
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Term
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Definition
MoA: selective, competitive reversible inhibitor of Type II 5-alpha reductase --> decreases production of intraprostatic DHT;
Efficacy: DRUG of CHOICE in pts who CANNOT use alpha-adrenergic antagonists b/c of CV ADRs; 2nd line for moderate/severe BPH;
Dose: 5 mg PO daily;
Preg. Cat X;
ADRs: erectile dysfunction, decreased libido, ejaculaotry disorders, increased serum testosterone levels, nausea, abd pain, asthenia, dizziness, flatulence, HA, gynecomastia, breast tenderness; |
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Term
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Definition
MoA: inhibits both Type I & Type II 5-alpha reductase --> induces more rapid & profound decrease in serum & intraprostatic DHT levels;
NOT proven to be clinically signifcant in pts w/ BPH;
Dose: 0.5 mg PO daily; |
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Term
| Combination Alpha-Adrenergic Antagonist + 5-alpha reductase inhibitors |
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Definition
| reserved in pts w/ enlarged prostate gland (> 40 g) who have significant voiding symptoms & who are at risk of BPH complications |
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Term
| Indications for Surgical Tx of BPH |
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Definition
severe bladder outlet obstructive symptoms (BOO) - more than 1 episode of acute urinary retention;
Presence of complications of BPH: recurrent UTIs, recurrent gross hematuria, bladder stones, renal failure;
Urinary flow rate <10 ml/sec; |
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Term
| Transurethral resection of prostate (TURP) |
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Definition
| GOLD STANDARD - associated w/ moderate rate of retrograde ejaculation & ED |
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Term
| Avoid drugs taht Exacerbate BPH symptoms |
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Definition
testosterone supplemets (stimulate BPH enlargement);
alpha-adrenergic agonists (decongestants);
anticholinergics (decrease detrusor muscle contractility);
diuretics (cause polyuria) |
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